Does Clarithromycin Cause Hearing Loss? A 12-Year Review of Clarithromycin Therapy for Nontuberculous Mycobacterial Lymphadenitis in Children

2018 ◽  
Vol 127 (10) ◽  
pp. 687-693 ◽  
Author(s):  
Colleen B. Heffernan ◽  
Mallory G. McKeon ◽  
Sasha Molony ◽  
Kosuke Kawai ◽  
Derek J. Stiles ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Care Center ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Loss To Follow Up ◽  
Institutional Review ◽  
Diagnosis Codes ◽  
Icd 10

Objective(s): The objective was to describe the characteristics of hearing losses documented in patients treated with clarithromycin alone for nontuberculous mycobacterial NTM lymphadenitis in a pediatric tertiary care center over a 12-year period. Methods: An institutional review board (IRB) approval was obtained. A database search was performed using the ICD-10 diagnosis codes 31.0, 31.1, and 31.8 between January 2004 and January 2017. A REDCap database was created to record variables. Patients were included if they received clarithromycin alone and had, at the minimum, a baseline audiology assessment, and 1 further evaluation during treatment. Fisher’s exact test was used to analyze categorical variables, and Wilcoxon rank sum test was used to analyze continuous variables. Results: A total of 167 patients with cervicofacial NTM were identified. Of them, 42 patients fulfilled inclusion criteria. Three children (7%) developed a hearing loss (HL) between 25 and 63 days after starting treatment. HL was unilateral in 2 children. HL persisted in 1 child following cessation of treatment. However, this patient had Rubinstein Taybi syndrome, limiting our ability to attribute the HL solely to clarithromycin. Conclusion: We noted a 7% hearing loss rate in our series. Confounding issues, such as 1 patient with a syndrome potentially contributing to HL, and limitations to this study, including retrospective design and loss to follow-up, temper our ability to conclude that clarithromycin was the sole cause of these HL. However, enough supporting data for a role in clarithromycin causing HL exist that testing should be considered for patients undergoing long-term clarithromycin treatment.

scholarly journals Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Noman Ali ◽  
Nadeem Ullah Khan ◽  
Shahid Waheed ◽  
Syed Mustahsan
Keyword(s):  
Emergency Department ◽  
Enteric Fever ◽  
Care Center ◽  
Tertiary Care ◽  
Practical Importance ◽  
University Hospital ◽  
Categorical Variables ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Continuous Variables

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians. doi: https://doi.org/10.12669/pjms.36.6.2334 How to cite this:Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2334 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Changes in Pediatric Faculty Burnout During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Audrey M. Uong ◽  
Michael D. Cabana ◽  
Janet R. Serwint ◽  
Carol A. Bernstein ◽  
Elaine E. Schulte
Keyword(s):  
Emotional Exhaustion ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Academic Rank ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Exact Test ◽  
Faculty Burnout ◽  
Student’S T ◽  
The Impact

OBJECTIVES To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated workflow changes, such as deployment on pediatric faculty burnout in an early epicenter of the pandemic. We hypothesized burnout would increase during the COVID-19 surge. METHODS We conducted serial cross-sectional surveys of pediatric faculty at an academic, tertiary-care children’s hospital that experienced a COVID-19 surge in the Northeastern United States. Surveys were administered pre-surge (February 2020), during the surge (April 2020), and postsurge (September 2020). The primary outcome was burnout prevalence. We also measured areas of worklife scores. We compared responses between all 3 survey periods. Continuous variables were analyzed by using Student’s t or Mann–Whitney tests, and categorical variables were analyzed by using χ2 or Fisher’s exact test, as appropriate. RESULTS Our response rate was 89 of 223 (40%) presurge, 100 of 267 (37%) during the surge, and 113 of 275 (41%) postsurge. There were no differences in demographics, including sex, race, and academic rank between survey periods. Frequency of burnout was similar in all 3 periods (20% to 26%). The mean scores of emotional exhaustion improved during the surge (2.25 to 1.9; P = .04). CONCLUSIONS Contrary to our hypothesis, we found no changes in pediatric faculty burnout after a COVID-19 surge. Emotional exhaustion improved during the COVID-19 surge. However, these findings represent short-term responses to the COVID-19 surge. Longer-term monitoring of the impact of the COVID-19 surge on pediatric faculty burnout may be necessary for health care organizations to mitigate burnout.

scholarly journals Clinical Characteristics and Outcomes of Hematologic Malignancy Patients with Clostridium difficile Toxin EIA vs. PCR Positive Test Results

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S396-S396
Author(s):  
Matthew Ziegler ◽  
Daniel Landsburg ◽  
David Pegues ◽  
Kevin Alby ◽  
Cheryl Gilmar ◽  
...  
Keyword(s):  
Hematologic Malignancy ◽  
Tertiary Care ◽  
Positive Test ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Test Results ◽  
Exact Test ◽  
Academic Center ◽  
Chi Squared ◽  
Record Review

Abstract Background C. difficile infection is common in patients with hematologic malignancy. There is increasing recognition that molecular (polymerase chain reaction, PCR) based testing lacks specificity for infection, while detecting patients with colonization. The objective of our study was to evaluate characteristics of patients with toxin enzyme immunoassay (EIA) vs. PCR positive C. difficile test results. Methods A retrospective review of inpatients at a tertiary care academic center with hematologic malignancy and a positive C. difficile test from 1/2015 to 1/2016 was performed. Data on demographics, comorbidities, clinical features, and outcomes were collected using medical record review. Characteristics were compared between patients with EIA vs. PCR positive test results using chi-squared or Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. Results A total of 130 patients were included: 51% and 49% had a PCR positive and EIA positive result, respectively. Diagnoses included AML (42%), multiple myeloma (22%), and Non-Hodgkin’s lymphoma (13%). Antibiotic exposure was similar, with a median of 4 days of anti-pseudomonal antibiotics received in the prior 30 days. There was no difference in history of a positive C. difficile test in the prior year (12% in the EIA group, 10% in the PCR group, P = 0.71). Patients with EIA positive results were more likely to have a WBC ≥15/mm3 (18% vs. 6%, P = 0.02). However, there were no differences in presence of fever, stool frequency, or imaging evidence of colitis at the time of testing. Medications in the prior 72 hours were similar, including the use of proton pump inhibitors of ~40% and of laxatives of 28%. Clinical outcomes were also similar between patients with EIA vs. PCR positive tests: all-cause death (22% vs. 20%), recurrent CDI (9% vs. 13%), colectomy (1% vs. 4%), and megacolon (0% vs. 3%). Most patients received treatment with oral vancomycin for a median duration of 14 days. Conclusion In patients with hematologic malignancy, those with EIA vs. PCR positive C. difficile test results were clinically similar. These findings suggest that algorithms for testing and treatment of C. difficile in hematologic malignancy patients will need to be specifically targeted towards this immunocompromised population. Disclosures All authors: No reported disclosures.

scholarly journals Single Center Outcomes of Status Epilepticus at a Paediatric Intensive Care Unit

2015 ◽  
Vol 43 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Samir Shah ◽  
Namrata Shah ◽  
Robert Johnson ◽  
Alina Nico West ◽  
Narayan Prasad
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Tertiary Care ◽  
Unfavorable Outcome ◽  
Paediatric Intensive Care ◽  
Categorical Variables ◽  
Admission Diagnosis ◽  
Continuous Variables ◽  
Exact Test ◽  
Refractory Seizures

AbstractBackground:Status epilepticus (SE) is a frequent admission diagnosis to paediatric intensive care units (PICUs) and is associated with variable outcomes. We have audited our experience of patients presenting in SE at a Canadian PICU to determine unfavorable outcome variables.Methods:Charts of patients <18 years of age presenting in SE to a tertiary care PICU over a 10-year period were audited. Data were analyzed at three care-points: transport, the emergency department (ED) and the PICU. Patient outcome before PICU discharge was categorized as “favorable” for return to pre-status functioning level or “unfavorable” for new deficit/death. Student’st-test andthe Kruskal-Wallis test were used for analysis of normal and skewed continuous variables, respectively, and either Chi-square test or Fisher’s exact test for categorical variables.Results:189 patients (54% males) were identified with a median age of 1.9 years. Idiopathic SE had the highest incidence; infectious/vascular etiologies were associated with more unfavorable outcomes. Progression to refractory SE in the ED had a higher incidence of death (p<0.05). Patients with an unfavorable outcome had a higher incidence of apnea during transport (p=0.01), longer hospital stays (p<0.05), need for therapeutic coma (p=0.01), longer duration of therapeutic coma (p<0.05), need for mechanical ventilation (p<0.05), and recurrent or refractory seizures during inpatient stay (p<0.05). Multivariate analysis of unfavorable outcomes of patients in SE presenting to the PICU included renal failure, cerebral edema, apnea during transport, refractory seizures, and recurrent seizures.Conclusions:Refractory seizures in children presenting with SE are associated with worsened outcomes in the PICU.

scholarly journals Histomorphology of germ cell tumors at various anatomic sites: a 5 years study at a tertiary care centre

2021 ◽  
Vol 9 (10) ◽  
pp. 3079
Author(s):  
Manal A. Lateef ◽  
M. I. Lone
Keyword(s):  
Germ Cell ◽  
Malignant Tumors ◽  
Tertiary Care ◽  
Germ Cell Tumors ◽  
Cystic Teratoma ◽  
The Body ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Tertiary Care Centre ◽  
Exact Test

Background: Germ cell tumors (GCTs) are a heterogeneous group of neoplasms, which occur in the gonads, and at extra gonadal sites of the body. The aim of the study was to observe the different histopathological patterns of various GCTs in the body at all possible sites and to know their IHC staining patterns.Methods: The study was conducted for a period of 5 years from 2015 to 2019 and was an observational study. The recorded data was compiled and entered in a spreadsheet and then exported to data editor of SPSS Version 20.0. Continuous variables were expressed as mean SD and categorical variables were summarized as frequencies and percentages. Graphically the data was presented by bar and pie diagrams Chi-square test or Fisher’s exact test was applied for comparing categorical values. P<0.05 was considered statistically significant. All p values were 2 tailed.Results: A total of 93 cases were analyzed and the mean age of the patients was 27.8 years. Mature cystic teratoma was the most common histopathological variant and was mostly seen in the ovaries. There was a difference in age predilection of benign and malignant tumors. Most of the malignant GCTs were gonadal while EGCTs were likely to be benign. MGCTs (mixed GCTs) were mostly testicular in origin with only one MGCT being extragonadal.Conclusions: Mature cystic teratomas were the most frequent GCTs with frequent site being in ovaries. Out 0f 18 EGCTs only 2 were malignant, rest all were mature cystic teratomas. 

Frequency of concomitant use of opioids and psychoactive medications among cancer patients referred to outpatient palliative care at a comprehensive cancer center.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 240-240
Author(s):  
Ahsan Azhar ◽  
Ali Haider ◽  
Angelique Wong ◽  
Maria Agustina Cerana ◽  
Madhuri Adabala ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Care Center ◽  
Symptom Assessment ◽  
Comprehensive Cancer Center ◽  
Categorical Variables ◽  
Cancer Center ◽  
Continuous Variables ◽  
Exact Test ◽  
Psychoactive Medications

240 Background: There are potential severe effects when patients taking opioids receive other psychoactive medications. However, such combinations are sometimes necessary in palliative care. The purpose of this study was to determine the frequency of concomitant use of opioids + psychoactive medications in cancer patients referred to our outpatient palliative care center. Methods: Retrospective data obtained from consecutive consults was analyzed to determine the frequency of patients on opioids alone versus concomitant opioids + psychoactive medications at first presentation to our clinic. Association of type of medication with demographics and baseline characteristics was evaluated by Wilcoxon rank sum test for continuous variables and Chi-square (Fisher's exact) test for categorical variables. Results: Among 541 consecutive consult visits, 365 (67%) patients were taking opioids at the time of referral to our clinic: 209 (57%) were on opioids alone while 156 (43%) were on concomitant opioids + psychoactive medications [69 (44%) were on Opioid + Benzodiazepine, 46 (30%) were Opioid + Antidepressants, 41(26%) were on both). Patients in the concomitant groups were on higher Morphine Equivalent Daily Dose (MEDD, p = 0.007), had higher Edmonton Symptom Assessment Scores (ESAS) for pain (p = 0.017), anxiety (p < 0.001), depression (p < 0.001) and spiritual pain (p = 0.03). Conclusions: A large proportion (156, 43%) of cancer patients referred to outpatient palliative care was on concomitant opioids + psychoactive medications. These patients were on higher doses of opioids with higher levels of pain and psycho-social distress at the time of first presentation. Further studies are required to better understand the clinical implications of concomitant use of opioids + psychoactive medications in such patients.

scholarly journals Breast cancer in young women: A retrospective study from tertiary care center of north India

2017 ◽  
Vol 06 (02) ◽  
pp. 051-053
Author(s):  
Deepti Sharma ◽  
Garima Singh
Keyword(s):  
Breast Cancer ◽  
Care Center ◽  
Tertiary Care ◽  
North India ◽  
Categorical Variables ◽  
Chi Square ◽  
Biological Behaviour ◽  
Exact Test ◽  
Poor Outcomes ◽  
The Impact

Abstract Aim: Breast cancer is the most common cause of cancer in women worldwide. They have more aggressive clinical behaviour with poor outcomes in younger patients. The aim of this study was to evaluate the impact of age on prognosis of breast cancer in women above and under 40 years of age. Material and Methods: Medical record of 415 patients with invasive breast cancer were analysed from January 2011 to December 2014 in our department.The last was done in December 2015.All cases diagnosed with breast cancer stages I to IV were evaluated, and grouped on the basis of age [less than 40 and above 40 years].Baseline categorical variables were analysed using the Chi-square test or Fisher's exact test. Non categorical variable were analysed using t-test. Result: A total of 372 patients were reviewed because 42 patients defaulted. The median age at the time of diagnosis was 44.6 years (range 23 to 90 years).Metastasis to distant organs were more in women with age <40. Tumour relapse occurred in 131 cases, among which 84 cases died, 35 patients (26.31%) in less than 40 group vs.49 patients (20.50%) in above 40 groups. The estimated median OS in the two groups are 32 and 41 months respectively. Conclusion: The biological behaviour of breast cancer in younger age group has been shown to be associated with aggressive nature and has a worse clinical outcome as compared to that in older group.

Prophylactic anticoagulation in pancreatic adenocarcinoma patients: A single tertiary care center retrospective quality improvement project.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16214-e16214
Author(s):  
Chelsea Peterson ◽  
Brittany Vannatter ◽  
Ryan Moll ◽  
Lynna Alnimer ◽  
Adriani Cherico ◽  
...  
Keyword(s):  
Total Pancreatectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Case Fatality ◽  
Primary Prophylaxis ◽  
Ductal Adenocarcinoma ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Bleeding Events ◽  
Improvement Project

e16214 Background: Pancreatic ductal adenocarcinoma (PDAC) cancer portends a poor prognosis with a high case-fatality rate. Venous thromboembolism (VTE) is a common complication in PDAC, due expression of tissue factor on neoplastic cells. Per most recent guidelines, anticoagulation for primary prophylaxis (PPx) of VTE is to be considered based on the Khorana score. The purpose of this study is to identify patients with PDAC and compare the outcomes of those receiving anticoagulation for primary prophylaxis versus those who did not. Methods: We performed a retrospective review of all patients diagnosed with PDAC from 2017-2019 at Allegheny General Hospital. Data analysis was completed using IBM SPSS v23. Summary statistics were presented using percentages for categorical variables and medians with interquartile ranges for continuous variables. Univariable and multivariable logistic regression models were used to study the predictors of developing VTE, expressed as odds ratio (OR). Means and percentages were compared using t-test and Chi-square test, respectively. Results: Out of 171 patients, 121 received treatment at our institution and were included in the analysis. Median age was 69 years, 54 (45%) were male. The majority were white (88%). Only 92 patients had complete data regarding VTE PPx and events. 26 patients (28.2%) developed at least one VTE event. Out of 92 patients, 12 (13%) were on one form of VTE PPx and 1 had a contraindication to VTE PPx. One patient without VTE PPx died secondary to VTE. Of the patients on VTE PPx, only 3 (30%) experienced bleeding events. Seven patients were on VTE PPx prior to diagnosis of malignancy. 58 patients (63%) had a Khorana score of 2; 21 (23%) patients had a Khorana score of 3; 9 (10%) patients had a Khorana score of 4; and 4 (4%) patients had a Khorana score of 5. On univariable analysis, St. IV disease (OR 3.34, CI.22-8.40, P < 0.01), planned surgery (OR 0.26, CI 0.12-0.55, p < 0.01) and unresectable disease (OR 3.19, 95% CI 1.17-8.70, p 0.02) were predictors of developing VTE. On multivariate analysis, total pancreatectomy had a predictive association in the development of VTE (OR 5.01, 95% CI 1.65-23.60, p < 0.01). There was no difference in average time to progression (months) between patients who had VTE vs those who did not (12.5 vs 11.4, p 0.60). Conclusions: Our analysis indicate that we may be underutilizing Khorana score to prescribe VTE PPx in patients with PDAC. Additionally, patients undergoing total pancreatectomy demonstrated predictive association with the development of VTE. With these findings, we believe education and increased awareness of the importance of the Khorana score may decrease the morbidity and mortality associated with VTE in patients with PDAC. The use of electronic medical records to prompt physicians to calculate the Khorana score will also likely be a helpful tool.

Microbiological and antimicrobial pattern of diabetic foot ulcers (DFUs) at a tertiary care center in North West, Pakistan

2021 ◽  
pp. 1-13
Author(s):  
Muhammad Arshad Siddiqui ◽  
Hamza Naeem ◽  
Muhammad Mohsin Ali ◽  
Fawad Ahmad Randhawa ◽  
Shahida Nazir ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Tertiary Care Center ◽  
Continuous Variables ◽  
Tissue Samples ◽  
North West ◽  
Antimicrobial Sensitivity ◽  
Diabetic Foot Infections

Abstract Objective: To determine the pattern of antimicrobial sensitivity of common microorganisms isolated from diabetic foot infections presenting at a tertiary care center in North West, Pakistan. Methods: 201 patients were included in the study, which was conducted over a period of 08 months from January 2019 to August 2019, at the Diabetes & Footcare Clinic (DFC), Mayo Hospital Lahore. Deep-seated tissue samples (0.5 x 0.5 cm) were taken from ulcer bed and immediately sent for culture & sensitivity (C&S) testing. Antimicrobial susceptibility was determined in accordance with Clinical & Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was performed using SPSS version 26.0. Data was presented as Mean ± SD for continuous variables & frequency with percentage for categorical variables. Results: Mean age of participants was 53.05 ± 10.70, from which 66.7 % (134) were male. Grade 3 DFUs (51.7%) and grade 2 DFIs were most prevalent (62.7%). Out of 201 tissue specimens, 389 bacterial isolates were collected. Monomicrobial specimens accounted for 28.4%, with the rest (71.6%) being polymicrobial. Gram negative organisms were 238 (61.11%) while the rest (38.89%) were gram positive organisms. There was a high incidence of methicillin resistant S. aureus (MRSA) at 64.58%. Highest susceptibility of S. aureus was reported with vancomycin and fusidic acid at 100% and 79.35%. Continuous...

scholarly journals Caregiver Burden among Caregivers of Mentally Ill Individuals and Their Coping Mechanisms

2018 ◽  
Vol 09 (02) ◽  
pp. 180-185
Author(s):  
Sujata Chodankar Walke ◽  
Varalakshmi Chandrasekaran ◽  
Shreemathi S. Mayya
Keyword(s):  
Mentally Ill ◽  
Care Center ◽  
Tertiary Care ◽  
Coping Mechanisms ◽  
External Support ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Physical And Mental Health ◽  
Cross Sectional ◽  
Brief Cope

ABSTRACT Background: During a given year, almost 30% of the people around the world are affected by mentally ill health. In India, it accounts for about 20%. Caregivers face a lot of strain, ill health, and disrupted family life, with literature suggesting an increasing concern about their ability to cope up. The needs of caregivers of the mentally ill are given low priority in the current health-care setting in India. Aim: The aim of the study was to assess the burden of caregivers of mentally ill individuals and their coping mechanisms. Methods: A cross-sectional study was employed with a quantitative approach. A convenient sample of 320 caregivers was taken from two private tertiary care centers and one public secondary care center in Udupi taluk. This study was conducted using the Burden Assessment Schedule (BAS) and Brief Cope Scale (BCS). Statistical analysis was done on categorical variables, and they were expressed as frequencies and percentages. Continuous variables were measured using mean and standard deviation. Univariate and multivariate analysis using binomial logistic regression was done. SPSS version 15 was used to analyze the data. Results: According to BAS, severe burden accounted for 40.9% and moderate for 59.1%. The highest amount of burden was seen in the areas of physical and mental health, spouse related, and in areas of external support. The BCS showed that the most frequently used coping styles were practicing religion, active coping, and planning. Conclusion: This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services.

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